Transforming how people experience the NHS

A key focus in the government’s Long Term Plan for the NHS is to empower patients through the use of digital technology, says Andy Smith, programme head at NHS Digital

In order to create a truly digital NHS, patients are going to have a key role in protecting their own health, choosing appropriate treatments and managing their long-term conditions.

NHS Digital is working hard to transform the way that people experience the NHS, by designing digital health tools and services that connect them to the information and services they need, when they need them.

One of the ways this is being achieved is through the NHS Apps Library, which houses a range of digital tools offering personalised advice, self-care and signposts to health services.

What is the NHS Apps Library?
The NHS Apps Library brings together all the apps and digital tools that have been assessed by the NHS. Its purpose is to help users find quality products from the wide selection available on the market.

Since launching in April 2017, it’s gone on to have more than a million visits and is currently home to 74 health-related apps covering a range of topics from mental health to pregnancy. Every app and digital tool published on the Apps Library has been reviewed by experts to provide reassurance to users that they are safe and secure and can be used to help improve health and wellbeing outcomes.

In what is a very crowded marketplace, we’re trying to help patients choose the best app for their condition by saying that ‘these apps have been assessed to a high standard and are OK to use’.

We’re sponsored by NHS England through their Empower the Person programme and our aim is to help patients and citizens to take more control over their own care by creating a tailored healthcare journey, which is a key part of the Secretary of State’s tech vision for the future.

Up to now, 374 apps have applied to be featured on the NHS Apps Library and 171 are currently going through the assessment process. The words most searched for are ‘anxiety and stress’. We also have quite a few who are looking for support with diabetes and pregnancy but coping with mental health is certainly the most frequent search request.

Assessing the suitability of the apps:
All apps applying to feature on the NHS Apps Library must be assessed against our Digital Assessment Questionnaire (or the DAQ as we call it). The DAQ was set up as a unique cross-body initiative – with the Department of Health & Social Care, NHS England, Public Health England, NICE and the Medicines and Healthcare products Regulatory Agency all sharing their areas of expertise and feeding into what’s now an extremely comprehensive question set.

Throughout the questionnaire we’re looking at risk and evidence of effectiveness, so we’re asking a whole host of questions like: ‘does the app really do what it says on the tin?’ and ‘does it meet our security standards?’ If patients are sharing their personal data, they need to be absolutely certain that their data is secure.  

If you think of every app assessment as being like a journey, you’ve got lots of different apps with different standards and different risks. We’ve got one called Brush DJ, for example, which is really low risk. You download it to your phone and you give it permission to access your music. It then plays music for two minutes, so a child knows how long to brush their teeth; giving a countdown when there’s 20 seconds left. It doesn’t access any personal data and it doesn’t store any personal information.

At the other end of the spectrum, we’ve got the likes of Evergreen which accesses the current GPSOC system; enabling patients to view their medical records, order repeat prescriptions and book appointments. By its nature, this is obviously far more complex to assess. After all, a pair of shoes is a transport mode and so is a rocket, but you wouldn’t assess them in the same way. It’s about breaking the assessment down into a manageable process and that’s what we’ve come up with through the DAQ.

The Digital Assessment Portal:
We currently work with one external assessing organisation called Orcha, but we’re in the process of launching an approved assessor operating model where third-party assessors will assess apps on behalf of the NHS. So very soon, app developers will be able to access a marketplace where they will be introduced to a list of organisations who can assess their apps against the NHS standard.

This assessment portal is also quite unique and we’ve had quite a lot of interest from other public departments, who are interested in how they could use such a system for their own digital needs.

We’re also creating an API which allows clinical systems to showcase the apps that are trusted. So in the future, GPs will be able to look at a problem and see instantly whether there is a digital solution. For example, if a patient presents with sleep problems, the GP might point them towards a particular app before they prescribe any medication.

Driving standards:
There are currently around 330,000 health apps worldwide. Some are very good, but a lot of them are rather poor, so by opening up the market and encouraging organisations to assess against the NHS standard, we are getting closer to being able to mandate that standard across the whole NHS. NHS England’s diabetes programme, for example, will not commission any app which does not appear on the NHS apps library.

But driving up standards is not just about raising the bar for user experience. We’re also looking to take out a lot of the legwork for GPs and commissioners, and the feedback so far is that commissioners are breathing a sigh of relief because they don’t need a security expert or a clinical safety expert to assess the apps they’re looking to use. If those apps are on the NHS apps library, they can rest easy that they have achieved all the relevant standards.  

User input:
We’re currently on version 2.3 of the DAQ and we’re updating it on a quarterly basis, so a lot of lessons learnt are constantly being fed into it. There are a lot of user researchers working on the programme and their role is to interview patients, developers, commissioners and healthcare professionals. It’s one of the most user-centric designs we’ve ever implemented. Absolutely everything we do is tested on the users first.

Working with app developers:
Since the launch we’ve worked with 350 developers and we’re working with them all the time to offer the smoothest service possible. Their main priority is to get their app on the library and for it then to be easily commissioned or used within the NHS. One of the ways we’re looking to improve this process is by putting the apps onto buying catalogues. So, if a commissioner has a particular health need that they’re looking to address, they can visit the catalogue to see which trusted tech solutions are out there. Once they’ve found an app or tool that works for them, they can then engage directly with the developer.

I think initially the app developers found the due diligence process quite a challenge, but we’ve done a lot of work on simplifying this process - without diluting any of the standards. What we have found is the process has forced developers to make key improvements, particularly in the GDPR area. There were lots of cases where developers were looking at our assessment process and thinking: ‘well, my app doesn’t do that’. But the end result is they’ve gone away and improved their app to meet that standard.   

Patient benefits:
The benefits for patients are plentiful. Even here in my own team, one of my colleagues has started using an app to monitor his diabetes, which has led to him being able to reduce his diabetic check-ups from once every month to once a quarter. He’s able to submit blood readings through the app, which can be seen by his doctor, and this in turn is freeing up more appointments for others, which is excellent.

International impact:
The impact of the NHS Apps Library is not restricted to the UK however, and has already prompted a lot of interest from overseas. Sweden, Germany, Japan, America, Australia and Finland are just some of the countries who have contacted us for advice, as they work to build their own equivalent. Every one of them has said that the NHS is two-three years in front of where they are.

A group of 40 health tech workers from Sweden visited us to find out more about our work and France is keen to only surface apps that are already on our library. A lot of these countries don’t have a government-led health service in the same way that we do, but they are all looking to the NHS to set the standard worldwide.